Congratulations on your pregnancy! We thank you for allowing Triangle Women's Center to be involved in your care. Your pregnancy will be nothing short of a miracle and we look forward to sharing this special time with you. Prenatal care is the care you will receive before your baby is born. This care is the key to a healthy pregnancy. Please help us to give you and your baby the best care possible by keeping all scheduled appointments. We ask you to please keep this pregnancy guide and refer to it as a vital source of information.

We welcome the baby's father and your family to share this wonderful experience with you. However, we request that you limit your visitors to no more than two. Also, due to HIPPA (health information privacy protection act), we ask that any visitors that will accompany you to the office go back with you when you are called by the nurse. No information on your whereabouts will be given to family or friends after you have been called by the nurse.

You will have an ultrasound at the beginning in order to provide an expected date of delivery. You will be provided with samples of prenatal vitamins to take until your next appointment. These vitamins are very important and should be taken every day. Sometimes these vitamins may cause some nausea. Most patients do better taking the vitamins at night before bed to help with this. If you are unable to tolerate your prenatal vitamins, please notify the triage nurse.

After your pregnancy is confirmed you will be scheduled for a new OB workup appointment. This appointment will be extensive and will include:

               1. Medical history evaluation
                2. An education session
               3. Lab and blood work that includes your blood type, rubella status, hepatitis B, HIV, and syphilis testing,
                   and hemoglobin. You will also be tested for STD's and have a pap smear.
               4.A complete medical examination.

After this visit, you will be seen monthly until around 28 weeks. You will then be seen every two weeks until 36 weeks, and then weekly until you deliver. Your provider may also decide if your care requires more office visits. During each visit you will be weighed and your blood pressure checked. Your urine will be tested for protein, sugar and infection. You will also see one of our providers. We are proud to have an excellent staff of providers who will be involved in your care. Our office includes the very best physicians  and staff.

The physician  that is on call when you are in labor will deliver your baby. It is important to build a good relationship with your health care provider. Please don't be afraid to ask questions. You may have questions or problems that need to be addressed between office visits. Problems that are of a medical nature may need to be evaluated. During office hours please feel free to call our office and a nurse will be able to assist you. If you need immediate assistance, please let one of the secretaries know and a nurse will be made available to you. Should your problem require an office visit, our nurses will work you into our daily schedule. It is important for you to talk with our staff if you are experiencing problems rather than a friend or relative. SHOULD YOUR PROBLEM BE A MEDICAL EMERGENCY, CALL 911 OR GO TO THE EMERGENCY ROOM AT Wake Med CARY HOSPITAL.  

   Triangle Women's  Center

    Monday  to Friday   9:00 a.m -5 p.m.
    Lunch 1pm  -2 pm
    Saturday  & Sunday  Closed.
    (919) 342 - 5383

Your pregnancy is divided into three trimesters

During the first trimester (months 1-3), there are many changes that take place in your body. Your hormones are changing and your body is preparing for the birth of your baby.

COMMON EARLY SIGNS OF PREGNANCY:

               Slightly enlarged and tender breasts
               Frequent urination
               Morning sickness
               Mood swings
               Fullness or ache in the pelvis
               Weight gain or loss
               Increased vaginal discharge
               Fatigue

IN THE FIRST TRIMESTER

Your baby:

               Has a heartbeat
               Forms major organs
               Has a head, tummy, arms and legs
               Has hands, fingers, feet and toes
               Grows to 3-4 inches long and weighs 1 ounce
               Moves but you can't feel it

MORNING SICKNESS

Morning sickness is caused by hormonal changes in your body during pregnancy. You may experience this in the morning, or during other times of the day. Morning sickness usually begins during the sixth week of pregnancy. It will usually run its course during the first trimester. To help ease morning sickness:

               1. Eat a high protein snack before going to bed.
               2.Get out of bed gradually in the mornings. Try to eat a few soda crackers before getting
                  out of bed.
               3. Eat small meals throughout the day.
               4. Avoid fatty or greasy foods.
               5. Drink fluids between meals.
               6. Get exercise, rest and fresh air.   

IF YOUR MORNING SICKNESS IS SEVERE, OR YOU ARE UNABLE TO KEEP ANYTHING DOWN INCLUDING LIQUIDS FOR 24 HOURS, CALL OUR OFFICE.

WARNING SIGNS DURING THE FIRST TRIMESTER

One of the most frightening things to experience during the first trimester is bleeding. This is the most common symptom that will send a woman to her physician. No bleeding during pregnancy is normal. If you experience bleeding, however, do not panic. Most of the time bleeding is harmless. Since miscarriage should be ruled out when there is bleeding, you should call our office and report your symptoms.

WARNING SIGNS OF MISCARRIAGE

               Abdominal cramps or pain
               Vaginal bleeding
               Passage of clots or whitish or grayish tissue

HAZARDS DURING PREGNANCY

These hazards may be in your home or where you work. You should avoid the following:

               x-rays
               workplace, household and garden chemicals
               lead
               soiled cat litter
               hot tubs, saunas, tub baths over 102 degrees
               perms and hair coloring are okay to do during pregnancy, but keep in mind the curl or color may not
               take.

EXPOSURE TO CHICKEN POX

If you have already had chicken pox in the past, you should not worry about exposure during pregnancy. If you have not had chicken pox before pregnancy you should avoid possible exposure for the first 12 weeks of your pregnancy.

EXPOSURE TO FIFTH'S DISEASE

Signs: red or rosy rash on cheeks, arms and legs that comes and goes over 1 to 3 weeks. You may have a slight runny nose or sore throat. Pregnant women that have been exposed to a child with fifth's disease before the child develops the rash, call your doctor. A sample of blood will be drawn for an antibody test to see if you already had the disease and are protected from becoming infected again.

ALCOHOL, TOBACCO AND OTHER DRUGS CAN HARM YOU AND YOUR BABY

Risks include:
               Miscarriage
               Premature birth
               Low birth weight
               Birth defects
               Do not drink alcohol while you are pregnant or breast feeding
               Avoid or limit caffeine
               Stop smoking and avoid second hand smoke
               If you use illegal drugs, get help and quit!

MEDICATION

The placenta does not act as a barrier between your baby and the drugs or medications you take during pregnancy. A medication that was prescribed for you in the past may or may not be safe for you to take during pregnancy. It is best to avoid medications during pregnancy, especially during the first trimester.

Our medical providers will work closely with you and monitor the medications you require to achieve the optimal balance between your medical needs and the safety of your unborn child. In this pamphlet you are provided a list of common complaints and medications you can safely take. Please do not hesitate to question the use of medications that you may be unsure of.

IN YOUR SECOND TRIMESTER (MONTHS 4-6)

During your second trimester your routine office visits will be monthly. You will be examined by a physician or certified nurse midwife during each visit. You will be monitored for weight gain or loss, blood pressure, circumference of the abdomen, position of the fetus and fetal heart beat. Your urine will also be checked for protein, sugar and infection at each visit.

                                   YOUR BABY                                                                                             YOU

                                 Can move and kick                                                            Will start to feel your baby move
                                 Starts to develop hair                                                         May start to see weight gain
                                 Can hear your voice and heartbeat                                 May have a dark line down the center of your abdomen
                                                                                                                                caused by hormonal changes. 11-14” long and weighs 1-1 ½ lbs.  
 

At the end of the second trimester is

ULTRASOUND

Our office performs an additional ultrasound after the 18th week of pregnancy. This is done to check the growth of your baby. Additional scans may be done later in your pregnancy if our physicians feel that your baby needs to be monitored for well being. We do offer “reassurance scans” if you would like a more lengthy scan or if you would like to know the sex of the baby. These scans are not covered by insurance since they are not considered a medical necessity. Please ask the office staff to provide you with prices for this particular ultrasound.

PRENATAL TESTING

Prenatal testing is any test done before your baby is born. This is done if your child has or is at risk for birth defects or genetic disorders. Certain tests will be offered to you depending on your age, health, and family history. These tests are elective, but available to you. Listed below are some screening tests we offer or can arrange for you to have if medically necessary.

    Screening test for Cystic Fibrosis
    Level II ultrasound
    AFP (done between 16 - 18 weeks) to check for Down Syndrome, Trisomy and neural tube defects
    Genetic Counseling
    Amniocentesis
    Chorionic villus sampling
    Nuchal fold translucency screen(11-13 wks)

We routinely do prenatal blood sugar screening between 26 - 28 weeks of pregnancy. This simple blood test involves a finger stick after drinking a sweet drink that we will provide for you. This checks for Gestational Diabetes, a temporary condition that usually resolves after delivery. Women who develop this will be put on a special diet or may require medication to treat the condition. We also do a repeat Syphilis test at this time of your pregnancy. This is required by law. If your blood type is Rh negative, you will also have an antibody screen drawn at the same time and be expected to return as advised for an injection of Rhogam.
WEIGHT GAIN

A healthy diet and moderate exercise during pregnancy are essential for the well being of you and your baby. A woman of average size can expect to gain 25 - 35 lbs. This is a normal healthy range for you and your baby. If you are underweight or overweight at the beginning of your pregnancy, these values may change somewhat. Ask your healthcare provider to help you decide what a healthy weight gain will be for you.
TRAVEL AND AUTOMOBILE SAFETY

You may drive and travel during your pregnancy. You should continue to wear a seat belt. You should fasten your seat belt so that the lap part of the belt is snug across your upper thighs and under your protruding abdomen. The shoulder strap should be positioned between your breasts. Do not sit in a car for long periods of time. Every hour you should get of the car and walk around to stimulate your circulation. Please inform our office when you plan to take trips, especially in the third trimester. It is a good idea to obtain a copy of your OB records when you plan a trip.
EXERCISE

Unless you are having complications, it is safe to exercise during pregnancy. You may want to consider brisk walking, swimming, yoga, or exercise programs for pregnant women. It is always a good idea to check with your physician before starting an exercise program.
WARNING SIGNS

If you experience any of the following warning signs, please call our office.
Vaginal bleeding or spotting     Burning/painful urination
Leaking or gush of fluid from vagina     Blurred vision
Decreased fetal movement (after 22 wks. )     Persistent headaches
Abdominal pain     Chills, fever or rash
Dizziness or fainting     Persistent vomiting
Sudden swelling of face, hands or feet     Foul vaginal discharge

 
IN YOUR THIRD TRIMESTER (MONTHS 7 - 9)

Reaching your third trimester is a blessing, but it can also cause anxiety for some women. Learning as much as you can about childbirth will help your anxiety and help you feel more confident. You will begin to come for your appointments every two weeks beginning around 28 weeks. Once you reach around 36 weeks, you will begin coming every week until you deliver. At each visit your weight, blood pressure and urine will be checked. After 36 weeks, you will usually be checked at each visit to see if your cervix has begun to dilate. Your abdomen will be measured and the baby's heart rate will be checked.
YOUR BABY     YOU
Opens and closes its eyes     May have back pain or discomfort
Kicks and stretches     Colostrum (yellowish fluid) may leak from your breasts
The brain develops more quickly     You may have trouble sleeping
Your baby is about 20” long and weighs 6 - 9 lbs     You may experience shortness of breath
PREMATURE LABOR

Premature labor is when a woman goes into labor before 37 weeks of pregnancy. This can be very serious for you and your baby. Please contact us immediately if you should have any of the following.

    CONTRACTIONS THAT OCCUR 4-6 TIMES OR MORE IN ONE HOUR
    ABDOMINAL CRAMPS
    LOW, DULL BACKACHE
    INCREASE IN VAGINAL DISCHARGE, UNUSUAL DISCHARGE, OR IF YOUR WATER BREAKS
    VAGINAL BLEEDING

MORE TESTS

Once you reach 36 weeks, you will be screened for Group B Streptococcus (GBS) infection. This is a common infection that rarely makes adults sick. Between 10 - 30% of women carry GBS in their vagina and rectums. If GBS is passed to your baby during delivery it can cause serious problems in your newborn. Should you test positive for GBS, you will be treated with antibiotics during your delivery. You will also be screened for Gonorrhea and Chlamydia as advised by the CDC.
LABOR

Labor is rhythmical contractions of the uterus that open the cervix and allow the baby, membranes, and the placenta to be delivered. If you are experiencing labor, please call our office. It will be helpful for you to tell the nurse if your bag of waters has broken, if you are experiencing any bloody show, when your contractions started (frequency and duration) and how far you live from the hospital.

Braxton Hicks contractions are irregular contractions that can occur any time after the first trimester. Some women describe them as feeling like menstrual cramps. The intensity of pain does not increase with Braxton Hicks contractions. Drinking a couple of glasses of water and resting on your left side will sometimes make these irregular contractions subside.

True labor usually has three main signs:

    Contractions will occur regularly and can be timed. They may last 45 seconds to 1 minute and come every 10, 15 or 20 minutes. Over time the contractions will begin to come closer together and will begin to be more painful. You may feel pain in your back that radiates across your abdomen that feels like very strong menstrual cramps. Back labor feels like constant back pain or severe back pain that comes and goes.
    Bloody "show" is blood tinged mucus that may occur before real labor, but may also happen a few days or weeks before labor begins. Any bright red bleeding should be reported immediately.
    Rupture of membranes. This may feel like a gush of fluid or a slow "trickle" from your vagina. This is what is referred to as "your water breaking". Usually your water breaks towards the end of labor, but sometimes it occurs earlier.

If you believe you are in labor, and our office is open, please call and Press 0 TO tell our secretary that you think you are in labor. If our office is closed or in lunch break,PRESS 6 and tell your name and how many weeks and EXPECTED DATE OF Delivery to person who takes call and they will page oncall Doctor.If any dificulty with 342-5383 then call 919-831-5593 directly if you think you are in labor or need immediate medical assiatance.If still no response you can go to Wake Med Cary  Hospital labor & delivery if you are already more than 20 weeks.If less than 20 weeks go to ER.

AS YOU PREPARE FOR THE BIRTH OF YOUR BABY:

    Decide if you will breast or bottle feed your baby
    Take a childbirth class (contact WAKE MED WOMENS PAVILLION )
    Choose your birth partner
    Plan transportation to the hospital
    Know your options for pain relief during labor and delivery
    Arrange for child care for older children
    Choose your newborn's physician
    Pack a hospital bag for yourself and your baby

YOUR BABY'S PHYSICIAN

Our office does not provide care for your baby after it is born. You will need to choose a pediatrician or family practice physician for your baby. Please call or visit the practice you choose in case you need to fill out preliminary paperwork before your baby is born. Listed below are some of the physicians in this area that are affiliated with Central Carolina Hospital.

 R&R PEDS ( 919) 367-9834)

CARE PEDS  (919- 858-0600)

MARUTHI PEDIATRICS  (919 462-6206)

CORNERSTONE PEDIATRICS  (919) 460-0993

TRIANGLE PEDIATRICS  (919) 467-5543

WESTERN WAKE PEDIATRICS (919) 859-9991

(MUST CONTACT PRIOR TO DELIVERY WITH INSURANCE INFO)

 
FINANCIAL ARRANGEMENTS

Our OB package fee includes all of your prenatal visits, our doctor's fee for a normal vaginal delivery, and six weeks of postpartum care. Any other lab work, ultrasound or testing will be charged in addition to this fee. If you require a c-section, there will be an additional fee for each surgeon. There will also be additional fees for a high risk pregnancy.
PRIVATE INSURANCE

If you have private insurance, please bring your insurance card with you on your first visit. Our benefits analyst will contact your insurance company to verify benefits. With this knowledge we can verify your deductible and go over an estimate of your total charges with you. The portion of the bill not covered by your insurance, will be due by the 7th month of your pregnancy. This fee may be paid weekly, biweekly, monthly or in sum. You will need to sign a payment agreement. This is required by law. This agreement will list the terms and amount of your payment. You will be given a copy of this agreement. Please keep this along with any receipts or correspondence from your insurance company in regards to your pregnancy. Our computer will produce all the necessary insurance claims within two days of the date of service. The claim for our OB package fee will not be filed until after your delivery because it includes the delivery fee.




If you have questions about fees or financial arrangements, our collections analyst will be happy to help you.

DISABILITY FORMS/FMLA

If you would like for us to complete a disability form, we will be happy to do so for a fee of $10.00. Please allow 6 - 7 business days for the completion of each disability form.

We are pleased that you have chosen Triangle  Women's  Center for your obstetrical care. We look forward to sharing this special time with you and your family. Please do not hesitate to let us know if you have questions or concerns. We hope that each visit with us will be a pleasant one!